Tag Archives: Saline

It’s time to think about implant sizing! YAYYYYYYYYYY!!!!! [as I type this, I imagine children across America are cheering with delight–because the only thing better than Christmas coming early is that annoying girl with the blog getting her damn breast implants already!]

But seriously. It really is time for me to start thinking about what size I want my implants to be. No pressure, though. I’ll only be stuck with them for ten to fifteen years.

On Thursday morning I had a tissue expander fill with Dr. Festekjian. He filled me up with 75 ccs on the left–yowza, slow down there, Dr. F! No but please don’t, 75 ccs was awesome, thank you. I am now at 525 ccs on the left and 550 ccs on the right. We’re almost even!!!!

At next week’s fill with Maria, I will get 75 ccs on the left and 50 ccs on the right, putting me at 600 ccs on each side. I’m sure what you all want to know is what cup size is that?!

Yes, I’d like to know that, too. So this morning I started to investigate.

The world of tissue expanders and breast implants is terrifying. I have emerged from the deep, dark pit of the Interwebz even more confused than when I started.

This is what I have discovered: I have two Natrelle Style 133SX tissue expanders. They are each 14 cm wide. According to the Natrelle catalog, they have a height of 12 cm and a projection of 7.1 cm and are considered “extra-projection range.” What does that all mean? No idea.

At this point, I am abandoning the science of it until I can talk with Dr. Festekjian, Maria or Jeani about it in person next week. Instead, I am going to play a kind of twisted form of dress up: the Breast Implant Rice Test! Or, in my case, The Breast Implant Israeli Couscous Test!

A few months ago, Jeani explained this test to me but I brushed it off as pretty much ridiculous. However I came across it again today and decided to just try it. 7/8 cup of Israeli couscous and a knee-high nylon sock (sorry Mom) in hand, I ventured into my room.

If “gummy bears” are the Prada of the implant world and silicone is the Coach, then Israeli couscous and nylons must be the Walmart brand.

Why 7/8 cup of Israeli couscous? Well, the handy little chart from www.justbreastimplants.com said that 1 cup of rice was roughly equivalent to 236 ccs, while 3/4 cup was about 177 ccs. Since my tissue expanders can hold a maximum of 750 ccs and my right expander is currently at 550 ccs, I wanted to experiment with about 200 ccs…so 7/8 cup of couscous sounded accurate.

Here’s the results–keep in mind I only tried the test on my right breast, since my left tissue expander is still a few ccs smaller:

Now obviously it looks a bit awkward with the rest of the nylon sticking out, but the test was more successful than I expected.

Yet I still don’t know how I feel about the size potential! The fact is that tissue expanders are shaped differently than breast implants. I need to find out from Dr. Festekjian what kind of implant he plans to use. Right now, when I look at myself head-on, my chest seems to be very filled out; but when I see myself from the side, it still seems very small. I guess this has to do with the tissue expander being wide?

Perhaps next weekend I will try the rice test again, but on both sides (since they’ll finally be the same size again!)

Can anyone speak to their experience with implant sizing?

In other news, I’m sick–but don’t worry, it’s (for once) NOT related to my tissue expanders! On Tuesday I started to develop a sore throat, and by Wednesday afternoon I could barely talk. I stayed home sick from work on Thursday. I felt AWFUL…couldn’t swallow because my throat was so sore, couldn’t sleep…finally saw a doctor on Friday and I’m on antibiotics now. I know, right–more antibiotics?! Ha. Let’s hope I don’t get sick for years after this, because all that nasty little bacteria is going to be SO antibiotic-resistant!

I’m feeling much better today. My mom is coming home today from Yosemite. I heard my dad on the phone with her yesterday, remarking about how I was a horrible patient. (Note to Dad: Yeah, yeah, stick it in your ear. Who do you think I got it from anyway? Plus, here’s a direct quote from “Jewish as a Second Language“, the book you gave me to read: “…should illness or injury strike you, it’s your duty to stay sick as long as you can. Keep using those crutches. Prop them up where everyone can see them. Flash that sling. Enlarge that bandage. Who knows when you’ll be dealt this card again?“)

It’s a good thing Mom is coming home now, because it’s probably her fault I’m sick. Let’s think about this for a minute: where was my mom when I got my cellulitis infection? The Grand Canyon. Where was my mom when I thought I had another infection a few weeks ago? Yosemite. Where was my mom when I got sick this past week? Yosemite, again.

COINCIDENCE? I THINK NOT! Once again, my mom has found a way to SINGLE-HANDEDLY ruin my life.

OK, I’ll stop dicking around now–I hope you all know I’m just being a brat for the sake of humor and that it’s an inside joke with my mom that was started in like, middle school.

I only mention being sick this week because, as much as it sucks, it’s kind of cool in a way that it wasn’t related to my mastectomy or reconstruction at all! It was just because I’m a normal person who can contract normal person contagions from other normal people. I’m normal, ya’ll!

Last Thursday I had my first tissue expander fill since having the left expander inserted on July 30. It was AWESOME–simple joys, right? I was so excited and anxious that I told myself I was going to let Dr. Festekjian do the fill without numbing me up. Of course I reneged on this decision, since I am a baby when it comes to pain and just the sight of the syringe and needle scared me into the numbing cream.

The numbing cream only delayed the process by a few minutes so it was totally worth it; I could barely feel the needle go in. Dr. Festekjian filled up the left side with 75 ccs of saline. We are going to let the left tissue expander “catch up” to the right tissue expander before we resume fills on that side. Right now my left side is at 325 ccs and my right is at 550 ccs. Each tissue expander can accommodate 750 ccs of saline. I anticipate I’ll need about nine more fills (at 50 ccs each) until I reach the maximum capacity.

On Sunday morning, Bryce and I woke up bright and early for the Making Strides Against Breast Cancer 5K walk in Santa Monica. I stayed up late the night before preparing my talking points for the survivor’s speech (or in my case, previvor). Bryce and I both wore Demand Media team t-shirts for the event and pink sunglasses; he looked very sexy in his pair, I must say.

Team Demand Media–I’m so proud to work with these people!

The event was small (compared to the 3-Day walks I’ve done in the past) but very successful and well-organized. There were at least 100 people there, and the sponsors included Demand Media (whoot whoot represent!), Equinox gym, and Go Country 105—my favorite radio station!

My “previvor” speech came after the address by an American Cancer Society rep. Since it was rather toasty outside, I tried to stay concise and upbeat. I ended up ditching my page of talking points as soon as I got up on stage. I mean, who am I kidding? This is MY story—I know it by heart!

I talked about my mom’s multiple cancer diagnoses and how I reacted to each one. In terms of her second diagnosis, I mentioned how angry and frustrated I felt and how many questions I had, and that those questions were all answered when we found out about the BRCA mutation. Then of course I talked about my own decision to have a prophylactic mastectomy, and though I’m fortunate to have that option, hopefully research will make it possible for my future children to have another more “civilized” option. I really wanted to connect a story about breast cancer to the walkers and their fundraising efforts, to let them know that the money they raised was going to help someone in a tangible way.

I walked in honor of my mom and my cousin Robbie.

After my speech, the walk started. We marched around a local park for about an hour; apparently four laps around said park is equivalent to a 5K. Once everyone was back from the walk, Kate (the Demand Media employee who helped plan the event) announced that we’d raised over $18,000! I was very impressed.

Kate did a stellar job organizing the event. It must have been very stressful for her to plan a charity walk while keeping up with her full time job. But she pulled it off and I’m proud to work with her. Good job, Kate!

Thanks for organizing the event, Kate!

Now, onto that product promotion I mentioned in the title of the post. I don’t do this very often so I feel that I’m allowed to include it now!

First off, my fabulous and talented mother Shirley Horn has decided (after much badgering from me) to launch her own online store, called Precious Survivors. What is she selling? Well, that is a good question! CUSTOM DRAIN POCKETS AND MASTECTOMY PILLOWS AND HAND-PAINTED ORNAMENTS! (Gee, that sounds swell!) Inspired by Trisha’s mastectomy and her hunt for a mastectomy bra, Mom created some adorable drain pockets. They have velcro attachments to connect to a mastectomy bra, and they are so colorful and cheerful. And they’re only $6 a pair!

Mastectomy pit pillows made by Shirley Horn

She is also selling handmade post-surgical “pit pillows”, heart-shaped pillows to rest under your arms after a mastectomy. My friend Kim gave me a pit pillow for my mastectomy, and it was perfect; it wasn’t too hard or too soft and my arm rested in the crevice without any pain. The pit pillows currently listed are Hello Kitty print, but Mom will take custom orders for a different fabric.

A portion of all of the sales from Precious Survivors goes towards breast cancer programs, such as the Los Angeles Pink Dragons, a dragon boat racing team of breast cancer survivors. Dragon boat racing is a great way for breast cancer survivors to prevent lymphedema, which can be caused by lymph node removal.

If you’re looking for a gift to give a loved one who is about to have a mastectomy, check out the Precious Survivors storefront. Mom created these products based on both of our experiences with mastectomies, so they are definitely patient-approved!

Now onto the other promotion. A few weeks ago I received a lovely email from a woman named Ann Victor, the president of PerfectCami, a fashion company. Recently Ann has designed a line of camisoles aimed at the post-mastectomy crowd. She graciously sent me a few to try out, and I LOVE them.

The camis attach to your bra straps and therefore stay in place when you bend over. I am always worried about people seeing the inserts on my left side; the camis prevent any accidental insert flashing! They also work nicely to cover bra cups and straps. The bras I wore before my mastectomy were underwire and the cups did not extend high up on my chest; the soft bras I use now have more fabric, so it’s difficult to wear any relatively low-cut shirts or dresses without the bra peeking through. The camis hide the bra perfectly.

If you’re interested in ordering any of the camis, visit the PerfectCami website. They come in a variety of colors and styles (I’ve got red lace, black lace, white striped, black striped, leopard and a few more!) and five sizes.

OK, signing off now. I have to get ready for my trip to Vegas this weekend! Have a great weekend everyone.

On Thursday afternoon I had my second tissue expander fill with Maria at Dr. Festekjian’s office. This time, Maria put some numbing cream over each tissue expander port. During my first fill Dr. Festekjian skipped straight to the biodine cleaning agent, so it was too late to put on the numbing substance; that’s why I could feel the needle pinch. At this appointment, however, I could barely feel anything–it was great! I will definitely be asking for the numbing cream from now on.

Maria put 50 ccs of saline into each side. I was a bit bummed that it wasn’t more, but I also understand that she wants to be cautious about not irritating my tissue and muscle too much. At least she filled up the left side! I am now at 350 ccs of saline on the left and 425 ccs of saline on the right.

After Maria did the tissue expander fill, Jeani (Dr. Festekjian’s assistant) came into the room to talk to me about silicone implants. She had a handy little spinning paper tool that let her see the minimum and maximum size for a silicone implant based on the width of my breast area (which Dr. Festekjian has determined to be 14 cms on each side.)

She also brought with her a few sample implants! I “tried” them on for size, which was fun but also strange! At this point I don’t really remember what my breasts looked like before surgery–I’m so used to the small size now. That being said I definitely want to go back to my “normal” size. Next week I am going to bring in one of my bigger bras and try on the different implant sizes with the bra. I’ll post pictures to get my readers’ opinions!

I didn’t feel any soreness after my tissue expander fill. However on Sunday and again this morning I’ve been in pain, particularly on the left side. When I raise my arms too high or stretch them to the side it hurts–a short of sharpness pulses through. I’m not sure what’s causing it, but it might be my sleeping position. On Saturday night I slept for a while on my stomach, which is the first time I’ve done that since before my mastectomy. I feel fine while I’m sleeping–no discomfort or soreness. Last night I slept the same way for a while and the pain is back again. I just don’t understand how the pain could be related to the sleeping position–wouldn’t my right side hurt a lot more, too?

Tonight I need to make an effort to not roll onto my stomach while sleeping. I took some pain meds this morning and decided to work from home so I could rest my arms. Hopefully the pain improves throughout the day!

Now for something more uplifting:

On Sunday I was lucky enough to help out a great cause during the LA Times Festival of Books at USC. I volunteered at the booth for The Jester & Pharley Phund, an organization which focuses on helping sick kids and promoting literacy. The story of the organization is touching: it centers around a book called The Jester Has Lost His Jingle, written by a young man named David Saltzman. During his senior year at Yale, David was diagnosed with Hodgkin’s disease. The Jester was created for his senior project. He died right before his 23rd birthday in 1990. The Jester is about finding happiness, laughter, and hope in an often depressing world; in fact the title character brings laughter back to the world after he talks to a little girl with a tumor.

After David’s death, his family worked to keep their promise to him that The Jester would be published. And they certainly fulfilled it! Over 325,000 copies have been published, and they are now taking orders for the first bilingual (Spanish-English) edition of the story.

David Saltzman, author of The Jester Has Lost His Jingle.

The Jester & Pharley Phund is the non-profit organization run by David Saltzman’s mother Barbara. Not only does the Phund donate copies of The Jester and the accompanying dolls to children at hospitals, its members also run literacy programs like Read-A-Thons in local schools. While volunteering yesterday, three of my fellow volunteers were fifth-grade students and their teacher who had learned about The Jester through a school program.

Barbara Saltzman and her staffers Amy and Connie were all very welcoming and grateful for the help. I stayed for about 2.5 hours and helped to sell books. When I left, Barbara gave me my copy of the book, signed by the Jester’s Mom!

It was so refreshing helping out yesterday. I love the way the Saltzman family has turned a sad story into an inspirational message. If you’re interested in purchasing a copy of the book, please visit the To Order section of TheJester.org.

After helping out at the booth, I went exploring around the Festival of Books and I met up with Teresa (from The Dog Lived blog) and her boyfriend. I stumbled across Teresa’s blog when I was doing a Google search of Dr. Karam way back in November. She was one of his patients. She turned her story of breast cancer and her dog’s cancer (he’s an adorable Beagle named Seamus) into an awesome blog, and soon that story will be turned into a book! I can’t wait to read it. It was really nice to meet Teresa in person…now I need to meet Seamus.

Yesterday I had my first tissue expander fill at Dr. Festekjian’s office.

For those of you who still aren’t sure of how the breast reconstruction process following a mastectomy works, here’s a rundown: after Dr. Karam performed the mastectomy (removing all breast tissue) portion of my surgery on March 13th, Dr. Festekjian came in to insert saline tissue expanders underneath a layer of my pectoral muscles. These tissue expanders are essentially little baggies that create a pocket in the muscle. They have a needle port on top, and over time, additional saline is inserted so that the baggie and the pocket can grow. Once the tissue expander has been filled enough and the muscle pocket is large enough, the tissue expander is removed and a permanent silicone implant is inserted into the pocket.

During my initial surgery, Dr. Festekjian put about 300 ccs of saline into each tissue expander. This is a pretty decent amount of saline, so when I woke up from my surgery, I actually had breasts–yes, they were small, an A cup, but there was still something there on my chest.

Yesterday Dr. Festekjian took a look at both sides. I was concerned because my left breast seems to be bigger than the right. It had only started to look like that a few days after my drains were removed, so I was worried that I had a fluid buildup. Dr. Festekjian said that there was no fluid (yes! The evil fluid, defeated!) but that the tissue on the left was “still a little pissed off” (wise words) and that it was swelling. He decided to expand only the right side, in order to make them match a bit more appearance-wise but also to let the left side heal more.

Maria, one of the RN’s in Dr. Festekjian’s office who is pretty much awesome (she removed my drains last Monday), did the fill. Sidenote: I really like Maria. She is very understanding and has a lot of patience. I took some before and after pictures, a picture of the tools, and also a video of the fill happening. Since I have to run to work right now, I’m only going to post the pictures.

These are the tools that are used for the tissue expander fill: the giant plastic syringe is where the saline goes, and the little green needle is what is actually inserted into the skin. The two connect at the top of the needle, and the saline is slowly pushed through the syringe into the needle and then into the tissue expander.

Before going to talk to another patient, Dr. Festekjian used a magnetic device to “locate” the tissue expander port through my skin. He then marked it with blue ink–“X marks the spot”, redefined! He disinfected my skin with some sort of brown substance, I think it was iodine. He then made sure I was OK with Maria performing the fill. He said he could do it himself, but I was already scheduled to see Maria the following Thursday for my second fill and I totally trust her, so I was fine with it.

The fill itself did not hurt, but I felt the needle prick for sure. That was the worst part (as it always is). I thought I would be able to feel the saline going into my tissue expander and making my muscle tighten, but I didn’t feel it at all. Maria was very slow and steady with the saline syringe.

She inserted 75 ccs of saline, removed the needle and then put a bandage over my skin where the needle had been. I could see a difference in that my breast didn’t look as droopy. I took a before and after picture, but since I have my bra on for both it’s kind of hard to tell. The biggest difference you can see is the fact that my bra doesn’t look as saggy.

On the left: before the expansion. On the right: after the expansion. Note that only the right side (in this case, looking at me, the left side) was expanded.

I thought I would be in pain after the fill. A lot of women experience tightness (from the muscle stretching) and have to take pain meds. It’s been almost 24 hours and I haven’t felt any pain at all.

My next fill is going to be next Thursday. Fingers crossed that I get both sides expanded! Jeani, Dr. Festekjian’s wonderful assistant, booked me for my next five fill appointments, every Thursday starting yesterday. We’re not sure I’ll need that many, but it’s nice to have them planned out.

Hi, I'm Rachel, your average twentysomething. I'm in a sorority, I just graduated from college and started my first full-time job, and oh yeah, I recently had a double mastectomy! Welcome to my world of BRCA genes, plastic surgery, and snap-in-front bras.

Looking for gifts for mastectomy patients? Check out Precious Survivors for mastectomy pit pillows and other gifts. A portion of the proceeds benefits breast cancer previvor and survivor organizations.